Did you know that an internal hernia can occur in a Petersen space? But what is a Petersen space?
Petersen space is the defect space that can sometimes occur in the mesentery between the alimentary loop of a gastrojejunostomy and the lower part of transverse colon mesentery after a gastric surgery.1
One of the complications that can arise following any type of gastrojejunostomy is a Petersen space hernia.
A Petersen space hernia can develop “when the intestinal loops protrude through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum.” 2
The hernia can occur anywhere from days to years after a gastric bypass.
Because it is an internal hernia, it is usually not visible thru the abdominal wall (i.e. protrusion like ventral hernias or umbilical hernias) and symptoms include severe abdominal pain and sometimes obstruction.1
Because of the increasing prevalence of gastric bypass, the occurrence of a hernia in Peterson’s space is more common than it used to be. Prior to this, it was typically only seen in the small amount of cases where a bypass was performed after gastric resection for things like severe ulcers and stomach cancer.
How do you code repair of a Petersen Space hernia?
In the coding scenario for a laparoscopic repair of an internal Petersen space hernia presented in AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2018, the correct ICD-10-CM PCS code would be “0DQV4ZZ Repair of mesentery, percutaneous endoscopic approach.” 3
If an open repair of the mesentery is performed for a Petersen Space hernia the appropriate PCS code would be 0DQV0ZZ Repair of mesentery, open approach.
Be sure and read the whole Operative Report description of the procedure for accurate code assignment.
Lorrie Strait, RHIT, CCS
Manager HIM Services
1. https://www.ncbi.nlm.nih.gov › pmc › articles › PMC319962
3. AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2018